Blood Cancer and Anemia

Anemia is the 'Check Engine Light' of Medicine

Anemia can be caused by the cancer, treatment, or both.

In a healthy person, anemia is kind of like the ‘check engine’ light on your car’s dashboard. It might be something, it might be nothing, but it shouldn’t be ignored.

Anemia refers to a deficiency in red blood cells or of hemoglobin in the blood. Anemia can also refer to an insufficient number of healthy red blood cells in circulation. The most common form of anemia is usually relatively benign. Sometimes, however, anemia can be the first indicator of cancer, or some other serious illness. In other cases, anemia is an expected side effect of life-saving anti-cancer therapy. Anemia related to cancer treatment causes a huge burden and can contribute to extreme tiredness.

Symptoms of anemia
Verywell / Brianna Gilmartin 

Cancer May Cause Anemia

There are a number of ways in which cancer can cause anemia. Some cancers produce blood loss, which can reduce the number of healthy red blood cells in circulation, causing anemia.

Blood is normally formed in the bone marrow. When a malignancy impacts the bone marrow, it might occupy the marrow space and reduce the body’s ability to produce new red blood cells, leading to anemia. Since red cells, white cells and platelets are all made in the bone marrow, these other blood cells can be impacted, too. In cancers that start in the bone marrow such as leukemias or cancers that spread to the marrow from other sites, as in some lymphomas, the fast-growing cancer cells crowd out the healthy, normal blood-making cells, leading to low blood counts, or anemia.

People who have had cancer or other chronic diseases for some time might develop what is known as anemia of chronic disease. This is thought due in part to disease-associated changes in the chemical signals that impact blood counts over an extended period of time. For example, many people with rheumatoid arthritis have anemia, and a large portion of such anemia is thought to be due to anemia of chronic disease.

Less commonly, blood cancers and other cancers may be associated with autoimmune problems that result in the immune destruction of ones own red blood cells. This is called paraneoplastic autoimmune hemolytic anemia.

And these are just a few of the many possible ways in which a malignancy may be associated with anemia.

Cancer Treatments May Cause Anemia

Chemotherapy can cause anemia by impairing hematopoiesis, or the growth and production of new blood cells. This can occur at the bone marrow, or in some instances, platinum-based chemotherapies can cause anemia to persist through reduced erythropoietin production by the kidney. Erythropoietin is a hormone produced by the kidneys that helps the body make red blood cells.

Radiation therapy to wide sections of the skeleton can also contribute to anemia, as can previous bone-marrow suppressing chemotherapy and the co-existence of chronic inflammatory diseases with the cancer.

Many current therapies for blood cancers are associated with anemia, so be on guard and talk to your healthcare provider about what can be done.

Anemia May Cause Problems in People with Cancer

Feeling very tired is a symptom that arises because cells in your body are not able to get enough oxygen. This lack of oxygen, if severe enough, can be serious or even life threatening. Your body tries to compensate for the anemia by making the heart work harder, so if you already have a heart problem, anemia can make it worse.

There is also the impact of anemia on planned cancer treatment to consider. When you develop anemia from a given treatment regimen, you and your healthcare provider might decide you need to delay your cancer treatment or have your dose reduced, in some cases.

Some Anemia Warning Symptoms

Tell your healthcare provider right away if you have any of the following serious symptoms of anemia:

  • Chest pain
  • Fast heart beat
  • Swelling in your legs
  • Feeling dizzy or lightheaded
  • Having trouble breathing when you exert yourself

Treatment Considerations

Treatment for anemia depends on the type of anemia you may be experiencing, including factors such as the precise cause, and the severity of your anemia. Depending on these factors, the plan might include dietary changes or supplements, transfusions, medicines, procedures such as blood and marrow stem cell transplants, or surgery to treat blood loss.

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  • Sources
  • American Cancer Society. Why people with cancer might need blood transfusions.  Accessed February 2015.
  • Puthenparambil J, Lechner K, Kornek G. Autoimmune hemolytic anemia as a paraneoplastic phenomenon in solid tumors: A critical analysis of 52 cases reported in the literature. Wiener klinische Wochenschrift. 2010;122(7-8):229-236.

By Tom Iarocci, MD
Tom Iarocci, MD, is a medical writer with clinical and research experience in hematology and oncology.